! Date : 08/18/98
Page : 1

JFK ASSASSINATION SYSTEM
IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : INSCOM/CSF
RECORD NUMBER : 194-10005-10140 .
RECORDS SERIES : DOD AFFILIATED PERSONNEL AND INCIDENT INVESTIGATIONS
‘AGENCY FILE NUMBER : PAGES 1110-1117

DOCUMENT INFORMATION

ORIGINATOR : USA
FROM :
TO :
TITLE : STATEMENT OF PERSONAL HISTORY
DATE : 10/05/66 ;
PAGES : 8
SUBJECTS : SCHEER, ROBERT

Io,
| DOCUMENT TYPE : PAPER, TEXTUAL DOCUMENT
| CLASSIFICATION : UNCLASSIFIED
RESTRICTIONS : 3
CURRENT STATUS : RELEASED WITH DELETIONS
DATE OF LAST REVIEW : 03/07/95
OPENING CRITERIA
COMMENTS

NW 60613 Docld:34530159 Page 1

ARMED FORCES SECURITY QUESTIONNAIRE

1.— EXPLANATION

1. The interests of National Security require that all persons
being considered for membership or retention in the Armed
Forces be reliable, trustworthy, of good character, and of com-
plete and unswerving loyalty to the United States. Accordingly,
it is necessary for you to furnish information concerning your
security qualifications. The answers which you give will be used
in determining whether you are eligible for membership in the
Armed Forces, in selection of your duty assignment, and for such
other action as may be appropriate.

2. You are advised that in accordance with the Fifth Amend-
ment of the Constitution of the United States you cannot be

compelled to furnish any statements which you may reasonably
believe may lead to your prosecution for a crime. This is the
only reason for which you may avail yourself of the privilege af-
forded by the Fifth Amendment in refusing to answer questions
under Parc IV below. Claiming the Fifth Amendment will not
by itself constitute sufficient grounds to exempt you from mili-
tary service for reasons of security. You are not required to
answer any questions in this questionnaire, the answer to which
might be incriminating. If you do claim the privilege granted by
the Fifth Amendment in refusing to answer any question, you
should make a statement to chat effect after the question involved.

H.—ORGANIZATIONS OF SECURITY SIGNIFICANCE

1. There is set forth below a list of names of organizations,
groups, and movements, reported by the Attorney General of che
United States as having significance in connection with the
National Security. Please examine the list carefully, and note those
organizations, and organizations of similar names, with which you
are familiar. Then answer the questions set forth in Part IV below.

2. Your statement concerning membership or other association
with one or more of the organizations named may not, of itself,
cause you to be ineligible for acceptance or retention’ in the

Armed Forces. Your age at the time of such association, cir-
cumstances prompting it, and the extent and frequency of
involvement, are all highly pertinent, and will be fully weighed.
Set forth all such factors under ‘Remarks’ below, and continue
on separate attached sheets of paper if necessary.

3. If chere is any doubt in your mind as to whether your name
has been linked with one of the organizations named, or as to
whether a particular association is ‘worth mentioning,’ make a

|

sidiaries and affiliates.

subsidiaries and affiliates, including—
Alabama People’s Educational Assdciation.
Florida Press and Educational League.
Oklahoma League for Political Education.

Virginia League for People’s Education.
Young Communist League.
Abraham Lincoln Brigade.
Abraham Lincoln School, Chicago, Illinois.
Action Commitee to Free Spain Now.

slavia, Inc.

time Unions.
American Christian Nationalist Party.

Birobidjan, Inc.
American Committee for Spanish Freedom.
American Committee for Yugoslav Relief, Inc.

Europe.

American Committee for National Unity.
American Council on Soviet Relations.
American Croatian Congress.

American Jewish Labor Council.

American League Against War and Fascism.
American League for Peace and Democracy.
American National Labor Party.
American National Socialist League.
American National Socialist Party.
American Nationalist Party.
American Patriots, Inc.

American Peace Crusade.

American Peace Mobilization.
American Poles for Peace.
American Polish Labor Council.
American Polish League.

United American Spanish Aid Committee).
American-Russian Fraternal Society.

lations with the Soviet Union).
American Russian Institute, Philadelphia.
American Russian Institute of San Francisco.

Los Angeles.

DD fO™ og
Nw 88614" Bocid:34530159 Page 2

Communist Political Association, its subdivisions,

People’s Educational and Press Association of Texas.

American Association for Reconstruction in Yugo-

American Branch of the Federation of Greek Mari-

American Committee for European Workers’ Relief.
American Committee for Protection of Foreign Born.
American Committee for the Settlement of Jews in

American Committee to Survey Labor Conditions in

American Council for a Democratic Greece, formerly
known as the Greek American Council; Greek

American Rescue Ship Mission (a project of the

American-Russian Institute, New York (a/so snown
as the American Russian- Institute for Cultural Re-

American Russian Institute of Southern California,

PREVIOUS EDITIONS OF THIS

American Slav Congress.

American Women for Peace.

American Youth Congress.

American Youth for Democracy

Armenian Progressive League of America.

Associated Klans of America.

Association of Georgia Klans.

Association of' German Nationals /Retchsdeutsche
Verernigung ).

Ausland-Organization der NSDAP, Overseas Branch
of Nazi Party.

Baltimore Forum.

Benjamin Davis Freedom Committee.

Black Dragon Society.

Boston School for Marxist Studies, Boston, Massa-
chusetts.

Bridges-Robertson-Schmidt Defense Committee.

Bulgarian American People’s League of the United
States of America.

California Emergency Defense Committee.

California Labor School, Inc., 321 Divisadero Street.
San Francisco, California. *

Carpatho-Russtan People’s Society.

Central Council of American Women of Croatian
Descent (also knoum as Central Council of Amer-
itan Croatian Women, National Council of Croa-
tian Women}

Central Japanese’ Association (Berkoku Chuo Nippon-
jin Kai). .

Central Japanese Association .of Southern California.

Central Organization of the German-American Na-
aonal Alliance ( Deutsche-Amerikanische Einbeits-
front)

Cervantes Fraternal Society.

China Welfare Appeal, Inc.

Chopin Culrural Cencer.

Citizens Committee to Free Earl Browder.

Citizens Committee for Harry Bridges.

Citizens Committee of the Upper West Side (New
York City). :

Citizens Emergency Defense Conference,

Citizens Protective League. . : :

Civil Liberties Sponsoring Committee of Pittsburgh.

Civil Rights Congress and its affiliated organiza-
tions, including Civil Rights Congress for Texas.
Veterans Against Discrimination of Civil Rights

Congress of New York. .

Columbians.

Comite Coordinador Pro Republica Espanola.

Comite Pro Derechos Civiles.

Committee to Abolish Discrimination in Maryland.

Committee to Aid the Fighting South.

Commitee to Defend the Rights and Freedom of
Pittsburgh's Political. Prisoners.

RE OBSOLETE (for Army use).

nm“: Bund (/ Amertkadeutscher Valbs-

full explanation under “Remarks.”

Organizations designated by the Attorney General, pursuant to Executive Order 10450, are listed below:
Communist Party, U. S. A., its subdivisions, sub-

Committee for a Democratic Far Eastern Policy.

Committee for. Constitutional and Political Freedom.

Committee for the Defense of the Pittsburgh Six.

Committee for Nationalist Action.

Committee for the Negro in the Arts.

Committee for Peace and Brotherhood Festival in
Phitadelphia.

Committee for the Protection of the Bill of Rights.

Commitee for World Youth Friendship and Cul-
tural Exchange.

Committee to Defend Marie Richardson.

Committee to Uphold the Bill of Rights.

Commonwealth College, Mena, Arkansas.

Congress Against Discrimination.

Congress of the Unemployed.

Connecticut Committee to Aid Victims of the Smith
Act.

Connecticut State Youth Conference.

Congress of American Revolutionary Writers.

Congress of American Women.

Council on African Affairs.

Council of Greek Americans.

Council for Jobs, Relief, and Housing.

Council for Pan-American Democracy.

Croatian Benevolent Fraternity.

Dai Nippon Butoku Kai / Military Virtwe Society of
Japan ar Military Art Society of Japan).

Daily Worker Press Club.

Daniels Defense Committee.

Dante Alighieri Society -*Betueen 1935 and 1940).

- Dennis Defense Committee.

Detroit Youth Assembly.

East Bay Peace Committee.

Elsinore Progressive League.

Emergency Conference to Save Spanish Refugees
(founding body of the North American Spanish Aid
Committee ). .

Everybody's Committee to Outlaw War.

Families of the Baltimore Smith Act Victims.

Families of the Smith Act Victims.

Federation of Italian, War Veterans in the U. S. A.,
Inc. (Associazione Nazionale Combattenti Ltaltani,
Federazione degli Stati Uniti a! America).

Finnish-American Mutual Aid Society.

Florida Press and Educational League.

Frederick Douglass Educational Center.

Freedom Stage, Inc.

Friends of the New Germany / Freunde des Neuen
Deutschlands).

Friends of the Soviet Union.

Garibaldi American Fraternal Society.

George Washington Carver School, New York City.

Page !

©


Germag American Republican League

German American Vocational League ¢ Deurshe
Amerskanishe Berufige-metnsehaft)

Guardian Club,

Harlem Trade Union Council.

Hawau Civil Liberties Commuttec.

Heimuska Kai. also known as Nokube: Hereki,
Gimusha Kai, Zaibel Nihonjin, Heivaku Gimu-
sha Kai and Zaiber Heimusha Kai / Japanese Re-
siding in America Miltary Conseripts Assocration)

Hellenic: American Brotherhood,

Hinode Kai ¢ fenperiatl Japanese Reservists)

Hinomaru Kai (Resing Sun Flag Socuty—a aroup
af Japanese War Veterans)

Hokuber Zaigo Shoke Dan ¢Nerth American Reserve
Officers Asta nation)

Hollywood Writers Mobilization for Defense.

Hungarian-Amernan Council for Democracy.

Hungarian Brotherhood.

idaho Pension Union.

Independent Party / Seutsle. Washington).

Independent People’s Pany

Industrial Workers of the World.

International Labor Defense.

International Workers Order, its subdivisions, sub-
sidiaries and affiliates

Japanese Association of America.

Japanese Overseas Central Society ¢Kuigai Dohn
Chuo Kar}

Japanese Overseas Convention, Tokyo. Japan. 1940.

Japanese Protectave Association / Recruiting Organ-
sation)

Jefferson School of Social Science. New York City.

Jewish Culcure Sociery.

Jewish Penple’s Committee.

Jewish People's Fraternal Order.

Jikyoku Lin Kai ( The Committee for the Criss).

Johnson-Forest Group.

Johnsonutes.

Jome Ant-Fascist Refugee Committee.

Joint Council of Progressive Italian-Americans, Inc.

Joseph Weydemeyer School of Social Science, St.
Louis. Missouri.

Kiber Seinen Kai ¢ Assocration of U.S. estrzens of
Japanese ancestry who have returned to America after
Mudying m Japan}

Knights of the White Camelia.

Ku Klux Klan,

Kyffhaeuser. also known as Kyffhacuser League
(Kyffhseuser Bund), Ky ffhacuser Fellowship (Kyf-
hacuser Kameradschaft)

Kyffhaeusee War Relief ( Kiffhacuser Kreegshilfiuerk).

Labor Council for Negro Rights.
Labor Research Association, Inc.
Labor Youth League.

League for Common Sense.

League of American Writers.

Lictor Society (ltahen Black Shirts),

Macedonian-American People’s League.

Mario Morganuni Circle.

Maritime Labor Committee to Defend Al Lannon.

Maryland Congress Against Discrimination.

Massachusetrs Committee for the Bill of Rights.

Massachusetts Minute Women for Peace (not con-
nected with the Minute Women of the U.S. A.
Inc.).

Maurwe Braverman Defense Committee.

Michigan Civil Raghts Federation.

1. Ser forth an explanation for each answer checked “Yes”
under question 2 below under “Remarks.”
extra sheets as necessary for a full explanation, signing or initial-

ing each extra sheet.

2. Title 18, U. S. Code, Section 1001, provides, in pertinent
part: “Whoever . . . falsifies, conceals or covers up . . . a ma-
statements . . . or makes
shall be fined not more than
$10,000 or imprisoned not more than $ years, or both.” Any
false, fraudulent or fictitious response to the questions under Part
IV below may give rise to criminal fiabilicy under Title 18,

terial fact, or makes any false
or uses any false writing .

NW sabia’ poeid-sashorse Page 3

Michigan Council for Peace.
Michigan School of Social Science.

Nanka Teikoku Gunyudan f Impertal Military briends
Group or Southern California War Veterans).

National Association of Mexican Americans (also
bnown as Asocracion Nacional Mexico- Americana }.

National Blue Star Mothers of America (not to be
confused with the Blue Star Mothers of America
organized in February 1942).

National Committee for the Defense of Political
Prisoners.

National Committee for Freedom of the Press.

National Committee to Win Amnesty for Smith
Act Vicums,

National Commuttee to Win the Peace.

National Conference on American Policy in China
and the Far East (2 Conference called by the Com-
mittee for a Demncratre Far Eastern Policy).

National Council of Americans of Croatian Descent.

National Council of American-Sovier Friendship.

National Federation for Constitutional Liberties.

National Labor Conference for Peace.

National Negro Congress.

National Negro Labor Council.

Nationalist Action League.

Nationalist Party of Puerto Rico.

Nature Friends cf America ¢ Since 1935)

Negro Labor Victory Committee.

New Committee for Publications,

Nichibes Kogyo Kaisha / The Great Fuyjit Theatre).

North American Committee to Aid Spanish Democracy

North Amertcan Spanish Aid Committee.

North Philadelphia Forum.

Northwest Japanese Association.

Ohio School of Social Sciences.

Oklahoma Comminee to Defend Political Prisoners.
Oklahoma League for Political Education.

Original Southern Klans, Incorporated.

Pacific Northwest Labor School. Seattle, Washing-
ton. 7

Palo Alto Peace Club,

Partido del Pueblo of Panama (operating in the
Canal Zone).

Peace Information Center.

Peace Movement of Ethiopia.

People’s Drama, Inc.

People’s Educational and Press Association of Texas.

People’s Educational Association / Incorporated under
name Los Angeles Educational Association. imc ).
also known as People's Educational Center. Peo-
ple’s University, People’s School.

People's Institute of Applied Religion.

Peoples Programs / Seatrie, Washington ).

People’s Radio Foundation, Inc.

People's Rights Party.

Philadelphia Labor Committee for Negro Rights.

Philadelphia School of Social Science and Art.

Photo League (New York Crty J.

Pittsburgh Arts Club.

Political Prisoners’ Welfare Committee.

Polonia Society of the WO.

Progressive Getman-Americans, also known as Pro-
gressive German-Americans of Chicago.

Proletaritan Party of America.

Protestant War Veterans of the United States, Inc.

Provisional Committee of Citizens for Peace, South.
west Area.

Provisional Committee on Latin American Affairs.

Provisional Committce ‘to Abolish Discrimination
in the State of Maryland.

Puerto Rican Comite Pro Libertades Civiles (CLC).

ll. — INSTRUCTIONS

Attach as many

U.S. C., Section 1001.
will not incur such liability unless you supply inaccurate state-
ments with knowledge of their untruthfulness. You are there-

~sttornquenos Unidos ¢ Puerto Ricans United ).

Quad City Commirtee for Peace.
Queensbridge Tenants League.

Revolutionary Workers League
Romanian-American Fraternal Society.
Russian American Society, Inc.

Sakura Kai (Patriotic Society, or Cherry Association,
composed of veterans of Russo-Japanese War).

Samuel Adams School, Boston, Mass.

Santa Barbara Peace Forum.

Schappes Defense Committee.

Schneiderman-Darcy Defense Committee.

School of Jewish Studies, New York City.

Seattle Labor School, Seattle, Washington.

Serbian American Fraternal Society.

Serbian Vidovdan Council.

Shinto Temples (Limited to State Shinto abolished
in 1945).

Silver Shirt Legion of America.

Slavic Council of Southern California.

Slovak Workers Society. .

Slovenian-American National Council

Socialist Workers Party, including American Com.
mittee for European Workers Relief.

Sokoku Kai (Fatherland Society)

Southern Negro Youth Congress.

Suiko Sha ¢ Reserve Officers Association, Los Angeles)

Syracuse Women for Peace.

Tom Paine School of Social Science, Philadelphia,
Pennsylvania.

Tom Paine School of Westchester, New York,

Trade Union Committee for Peace.

Trade Unionists for Peace.

Tri-State Negro Trade Union Council.

Ukramtan-American Fraternal Union,

Union of American Croatians.

Umon of New York Veterans.

United American Spanish Aid Committee.

Unired Committee of Jewish Societies and Lands.
manschaft Federations, also known as Coordina-
tion Committee of Jewish Landsmanschaften and
Fraternal Organizations.

United Committee of South Slavic Americans.

United Defense Council of Southern Califorma.

United Harlem Tenants and Consumers Organiza-
non.

United May Dav Committee

United Negro and Allied Veterans of America.

Veterans Against Discrimination of Civil Rights
Congress of New York.

Veterans of the Abraham Lincoln Brigade.

Virginia League for People's Education,

Voice of Freedom Commutee

Walt Whiuman School of Social Science. Newark
New Jersey

Washington Bookshop Association

Washington Committee to Defend the Bill of Rights

Washington Commitee for Democratic Action.

Washington Commonwealth Federation.

Washington Pension Union

Wisconsin Conference on Social Legislation.

Workers Alliance (srme April 1936)

Yiddisher Kultur Farband.
Yugoslav-American Cooperative Home. Inc.
Yugoslav Seamen's Club, Inc. .

You are advised, however, that you

fore advised that before you sign this form and turn it in to

US GOVERNMENT PRINTING OFFICE . 1961 O—607912

For Official Use Only

Selective Service or military authorities, you should be sure chat
it is truthful; chat detailed explanations are given for each "Yes"
answer under question 2 of Part IV below, and that details given
are as full and complete as you can make them.

3. In stating details, it is permissible, if your memory is hazy
on particular points, to use such expressions as, ‘I think,” “in
my opinion,"’ “I believe.”’ or “to the best of my recollection.”

Page 2

Page 4


1.

1V.— QUESTIONS

{For each answer checked “Yes” under question 2, se! forth o full explanation under ‘Remarks’ below)

l have tread the list of names of organizations, groups, and move-
menis set forth under Part Il of this form and the explanation which
precedes it.

1. Have you ever cantributed money to any of the organizations,
groups, or movements listed?

. Concerning the list of organizations, groups and movements set forth
under Part H above:

k Have you ever contributed services to any of the organizations,
groups, or movements listed?

Are you now a member of any of the organizations, groups, or
movements listed?

| Have you ever subscribed to any publication of any of the organ-
izations, groups, or movements listed?

. Have you ever been a member of any of the organizations, groups,
or movements listed?

. Are you now employed by any of the organizations, groups, or
movements listed?

Hove you ever been emploved by a foreign government or any
agency thereof?

Are you now a member of the Communist Party of any foreign
country?

Have you ever been employed by any of the organizations,
groups, or movaments listed?

. Hove you ever attended any meeting of any of the organizations, T

groups, or movements listed?

Have you ever been o member of the Communist Party of any
foreign country?

. Have you ever attended any social yathering of any of the argan-
izations, groups, or movements fisted?

. Have you ever attended any gathering of any kind sponsored by
any of the organizations, groups, or movements listed?

. Have you prepared material for publication by any of the organ-
izations, groups, or movements listed?

i. Have you ever corresponded with ony of the organizations, groups,
or movements fisted or with any publication thereof?

Have you ever been the subject of o loyalty of security hearing?

q. Are you now or have you ever been a member of any organiza-
tion, association, movement, group or combination of persons
not on the Attorney General's list which odvocates the overthrow
of our constitutional form of government, or which has adopted
the policy of advocating or approving the commission of acts of
force or violence to deny other persons their rights under the
Constitution of the United States, or which seeks to alter the form
of government of the United States by unconstitutional means?

r. Hove you ever been known by any other jast name than thot used
in signing this questionnaire?

ZL serve CE APS a Sees DP AOOST Pees,
Diu Se Tbe/ tvefese Ie FF 5A Grens: ode

HW ZIP wiper Soe SEES: LESLIE wn

vnfients Armerloorant 26 Ae LIL

fori fO9,

REMARKS (Continued)

NW/G0613 Docid:34530159 Page 4

Page 3

REMARKS (Continued) ~

Robert Scheer, born 4 April 1936 in Bronx, New York,
@ registrant under the Universal Military Training
Act, was this date given an opportunity to execute
DD Form 98 and in my presence he refused to do eo.

1/LT, AGC

CERTIFICATION

In regard to any part of this questionnaire concerning which I have had any question as to the meaning, | have requested
and have obtained a complete explanation. I certify that the statements made by me under Part IV above and on any supple-
mental pages hereto attached, are full, true, and correct.

TYPED FULL NAME OF PERSON MAKING CERTIFICATION SERVICE NUMBER (if any) SIGNATURE OF PERSON MAKING CERTIFICATION

TYPED NAME OF WITNESS ‘DATE SIGNATURE OF WITNESS

“4 3
US GOVERNMENT PRINTING OFFICE . 1961 O—607912

nw addr Bet aadsorse Page 5 For Official Use Only:

Page 4

At.


~~ fe

. STATEMENT @#-;,  38PAL HISTORY <omeommmases

1. iia

INSTRUCTIONS: Read the certification at the end of this questionnaire before entering the required data. Print or type all
answers. All questions and statements must be completed. If the answer is ‘“‘None,”’ so state. Do not misstate or omit material
fact since the statements made herein are subject to verification. If more space is needed, use the Remarks section, item 20, and
attach additional sheets if necessary. The information entered hereon is for official use only and will be maintained in confidence.

1, (Print) FIRST NAME—MIDOLE NAME--MAIDEN NAME (Uf any)—LAST NAME d e b
. nf MR. - - ~ sot 2. STATUS
Clues. ROBERT (NNN) SCHEER ; so.
Oo MISS. 7 ; | 4 l CIVILIAN ‘| ~ | turraay on ACTIVE DUTY
3. ALIAS(ES). NICKNAME(S). OR CHANGES IN NAME (Other than by marriage) 4, PERMANENT MAILING ADDRESS °
~~ “'Neone - : wv. .. | 2828 Milvie St., Berkeley, California

{ S. DATE OF BIRTH (Day, month, year)

4 April 1936

PLACE OF BIRTH (City, County, State, and Country) PLACE CERTIFICATE RECCRDED
Bronx,New York,New York,USA Bronx, New York
RACE HEIGHT WEIGHT COLOR OF EYES COLOR OF HAIR SCARS. PHYSICAL DEFECTS, DISTINGUISHING MARKS.

Cauc 70" 180 . Brown Brown None

6. DO YOU HAVE A HISTORY OF MENTAL OR NERVOUS DISORDERS? [_] ves HXKNO ARE YOU NOW OR HAVE YOU EVER BEEN ADDICTED TO THE USE OF HABIT FORMING DRUGS SUCH AS
NARCOTICS OR BARBITURATES? (] YES [Jf NO ARE YOU NOW OR HAVE YOU EVER BEEN A CHRONIC USER TO EXCESS OF ALCOHOLIC BEVERAGES? [_] YES fefhO IF THE
: ANSWER TO ANY OF THE ABOVE IS "YES." EXPLAIN IN ITEM 20, :

i 7,U,S. NATIVE JF NATURALIZED, CERTIFICATE NO. IF DERIVED, PARENTS’ CERTIFICATE NO(S). |. | DATE, PLACE. AND COURT

a kpe 7:
YES . a . ot

gg. 1; ee
NO

eyo wyas. Toa eee _onurs . :
ART ee ee ;
: ALIEN ReGisTRATION NOS 1) 7 FST NATIVE CouNTRY + N14) paTE-AND PORT OF ENTRY a, DO YOU INTEND TO BECOME :
top tase : . - = . AU. S. CITIZEN?
HEF Tce Jo. . - > :

[ves To

MILITARY SERVICE

| SERVICE AND COMPONENT — «+ -.- | ORGANIZATION AND STATION. i DATE CURRENT ACTIVE -
rau ra - aos ean : _-.. | / SERVICE STARTED

&

oy

GRADE AND SERVICE NO SERVICE AND COMPONENT ORGANIZATION AND STATION OR UNIT AND LOCATION

H HAVE YOU PREVIOUSLY SERVED TOURS OF EXTENDED ACTIVE DUTY. ORAWING FULL PAY, FROM WHICH YOU WERE DISCHARGED OR SEPARATED TO CIVILIAN STATUS? o YES i) NO
SE 'YES."’ COMPLETE THE FOLLOWING:

wee ee
COUNTRY SERVICE COMPONENT I ‘[T FROM (Date) | TYPE DISCHARGES OR SEPARATIONS—GRADE AND SERVICE NO.
\ m7 alueistn we ; .

. : aH

<
9. EDUCATION (Account for all civilian’schools and military academies. Do not include service schools)
,
MONTH AND YEARLY HOLA GRADUATE
, UEFEOEA DEGREE
\ FROM— ; uot ESE mes NO
| Sep 49
\ :
| Sep 53
Sep 55
ep coer ore rst aAguse Unive
i Bp Os pre-e un Gs fUnS Vera £1 Py

10. 7 FAMILY (Lis¢,/nionder ginenn par eras: gpouse guar diansy atépparanits,{fostéy patents, parénts!inz law} formez spouse(s) il divorced give date

. Tey Sedo. puonden sient ea: and sisters, cee hough seosecsat nelude arly’ others you resided with of vith whom a close relationship
existed or exists. If the person is not a U.S. citizen by birth, give date and port of entry, alien registration number, naturalization certificate
number and place of issuance.) . .

U.S. CITIZEN

RELATION AND NAME DATE AND PLACE OF BIRTH PRESENT ADDRESS, IF LIVING YES
FATHER 25 flay 1898
Fred Scheat, co iiss -teleuGermanyerueu* cou iccrs Penesebee Sug Isbeu -  ceTpé
MOTHER (Maiden name) 24 Apr 1900 —C«j 2660 Bronx Park East
Ide KOten Cae iin PR oe Bronx, New York
: SPOUSE (Maiden name Fab. 1942 ‘ 2628 ftilvie Street ‘
Anne Weills Eureka, Calif. Berkeley, Calif. x

OTHER (Specify)

None

Li CUE Sep a

Exception to Standard Form 86 _
~ Aaya f the Budget June 1960

nw sedi) Erteraktth a0 Bake 6 Gener arene ne peony,

Qe.


pane
nn e ne ae i -_
ea, Lincles, cm |

ee — oe mie ——

: — ENDS Livine IN FORFIGN COUNTRIES (13: srandparents, first cousins, aur

” 'brothsrs- ena cisters WW, ond cthes porsoms vith wham 92 cless relationship existed or ex::

—~- ———-
RELATIONSHIP AND NAME AGE OCCUPATION ADDRESS / ~ CITIZENSHIP
‘Wone
t

|
r
=

NAME OF IMMEDIATE
SUPERVISOR

4 ‘S Ji
Ue Se Post Office
New York City, New York
Syracuse University
Syracuse

SOCIAL SECURITY NO.

DID ANY OF THE ABOVE EMPLOYMENTS REQUIRE A SECURITY CLEARANCE? $[] YES MR NO DO YOU HAVE
ANY FOREIGN PROPERTY OR BUSINESS CONNECTIONS, OR HAVE YOU EVER BEEN EMPLOYED BY A FOREIGN
GOVERNMENT, FIRM, OR AGENCY? ([] YES (No HAVE YOU EVER BEEN REFUSED BOND? [7] Yes
XX] NOs IF THE ANSWER TO ANY OF THE ABOVE IS “YES,"" EXPLAIN IN ITEM 20.

112-268-1134

CREOIT AND CHARACTER REFERENCES (Do not include relatives, former employers, or persons living outside the

United States or its Territories.
; 1 “state or
* ': TERRITORY

ire

Tel ER

“ STREET AND NUMBER ht
Jr oeLise 3 cregiis rand § character ye

| (Basinesscuddress preferred z]

rea
fips]

|

NW 60613 Docid:34530159 Page f


19. ARE THERE ANY INCIDENTS IN YOUR LIFE NOT MENTIONED HEREIN WHICH MAY REFUECT UPON YOUR LOYALTY TO THE UNITED STATES O1

R UPON YOUR SUITABILITY TO PERFORM
THE OUTIES WHICH YOU MAY BE CALLED UPON To TAKE OR WHICH MIGHT REQUIRE/FURTHER EXPLANATION? oO YES O NO

(F *YES,"" GIVE DETAILS

See Remarks

Fic
20. REMARKS

MIG Kory ye CAbsec® sores seh) sayy x

go ooply

Bae Path moe v
ITEM gf12) FOREIGN TRAVEL Continued ) hen

FOE ya, Leh SB GGK BER goes
. rod @b..1966 to Mar 196605: "Vietnam, Combodia,Thailend and Japan - Write «

x
i Sar ad
a >

fo ange
errs Sa

AOLE

“yy

“rt :

I refuse to answer questions 16, 17, and 19 on the grounds that they violate my
‘constitutional: rights under: :the:-let, Sth 2 14th: Amendnents ‘to the United Statee
Gonstitutionsiv 5. HABMOMNCS he Vue te agengs tice Age a

eeh op GH Be Loe CYeaA 57, wh JOM AGES ca pose eee nee

iehose ow aD AseBe Papy mesure ® os hose v

Bou ta aRobert Scheer}: a: registiant under the Military Thaining © INR Gaye
and Service Act, refused to complete DD Form 398 in its

entirety.

MYRON K. HAYASHIDA
1/LT, AGC

1 CERTIFY THAT THE ENTRIES MADE BY ME ABOVE ARE TRUE. COMPLETE. AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND ARE MADE IN
GOOD FAITH. | UNDERSTAND THAT A KNOWING AND WILLFUL FALSE STATEMENT ON THIS FORM CAN BE PUNISHED BY FINE OR IMPRISONMENT OR BOTH
(See U. S. Code, title 18, section 1001)

ye
a

‘DATE

5 Oct 1966

SIGNATURE OF PERSON COMPLETING FOR

ANDSADDAE SE FS SIGNATURE OF WITNESS
~ HAVASHYBA, 1/LT, acc () * :
g 7% Jac ian > Pornia ZelVL7 HAY aye
THIS SECTION TO BE COMPLETED BY AUTHORITY REQUESTING INVESTIGATION
SIGNMENT AND DEGREE OF CLASSIFIED MATTER (top secret, secret, etc.) TO WHICH APPLICANT WILL REQUIRE ACCESS

“

ne.

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Peae rs)

et
DATE OF CLEARANCE

REMARKS.

U.S, GOVERNMENT PRINTING OFFICE : 1960 0—573450_

NW 88613 Docid:34530159 Page 8

nw

tT: STREET. AND, NUMBER, Boeds

a _ _ " "sTaTE on cour?
1949":") ‘1958 |

. 1968 |" ¥559 7 Spracuse N.Y. Married Student Housing i fae for

California

| 2961 | 1963 [ 2157 Mason Street | | ~—s (|| San Francisco | California |

[1964 | 1965 | 332 Castro St. & 2870 Geery || San Francisco | California |

| 2965 |

2628 Milvia Street California

TYPE

(Social, fraternal, profeasional, etc.)

NAME AND ADDRESS

See Remarks

ARE YOU NOW OR HAVE YOU EV! EN'A MEMBER OF THE COMMUNIST PARTY U. S. A.. OR ANY COMMUNIST ORGANIZATIONS ANYWHERE?

ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF/A FASCIST ORGANIZATION? tht

2 a OR
ARE YOY NOW OR HAVE YOU EVER BEEN A MEMBER OF ANY PRGANIZATION, ASSOCIATION, MOVEMENT. GROUP OR COMBINATION OF PERSONS WHICH ADVOCATES THE
OvERT Hon OF OUR CONSTITUTIONAL FORM OF GOVERNMENT, OR WHICH HAS ADOPTED THE POLICY OF ADVOCATING OR APPROVING THE COMMISSION OF ACTS OF FORCE
OR VIOLENCE TO DENY OTHER PERSONS THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES, OR WHICH SEEKS TO ALTER THE FORM OF GOVERNMENT OF

eee Tea TUT aah MEANS? <3 Luby (que tcwy ayeey
ce om ee ¥ 18

ARE YOU:NQW.OR HAVE you EVER BEEN AFFILIATED OR ASSOCIATED WITH ANY, ORGANIZATION OF THE TYPELDESCRIBED ABOVE AS AN AGENT. OFFICIAL, OR, EMPLOYEE? ;
set Pee mk : oo , . ‘ we Do, we

ao
ARE YOU NOW ASSOCIATING WITH, OR’ HAVE YOU ASSOCIATED WITH ANY INDIVIDUALS, INCLUDING RELATIVES, WHO YOU KNOW OR HAVE REASON TO BELIEVE. ARE OR
HAVE BEEN MEMBERS OF ANY OF THE ORGANIZATIONS IDENTIFIED ABOVE?

HAVE YOU EVER ENGAGED IN ANY OF THE FOLLOWING ACTIVITIES OF ANY ORGANIZATION OF THE TYPE DESCRIBED ABOVE: CONTRIBUTION(S) TO, ATTENDANCE AT OR
PARTICIPATION IN ANY ORGANIZATI NAL. hen OR OTHER ACTIVITIES OF SAID ORGANIZATIONS OR OF ANY PROJECTS SPONSORED BY THEM: THE SALE. GIFT. OR DIS-
)

Se cir oet
{TRIBUTION:OF ANY-WRITTEN, P(RIN: ED. Ra BER MAT EES PREPARED: REPROQUCED, OR PUBLISHED. BY THEM OR ANY OF THEIR AGENTS OR iINSTRUMENTALITIES?

IF “YES,” DESCRIBE THE CIRCUMSTANCES... ATTACH ADDITIONAL-SHEETS FOR A FULL DETAILED STATEMENT. IF ASSOCIATED WITH ANY OF THE ABOVE ORGANIZATIONS. SPECIFY NATURE

AND EXTENT OF ASSOCIATION WITH EACH, INGUUDING PRFICE;OR;POS|TION HELO; ALSO INCLUDE DATES. PLACES. AND CREDENTIALS NOW OR FORMERLY HELD. IF ASSOCIATIONS HAVE
i acpetetcan :

BEEN WITH INDIVIDUALS WHO ARE MEMBERS OF, THE ABOVE ORGANIZATIONS. THEN LIST THE INDIVIDUALS AND THE ORGANIZATIONS WITH WHICH THEY WERE OR ARE AFFILIATEO.

yeu Gr: eh Mg Se : wf oke “EYE:

Me Pe ty Ede] opaere

pos

Joos &

See Remarks

16. HAVE YOU EVER BEEN DETAINED, HELD, ARRESTED, INDICTED OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING. OR CONVICTED. FINED. OR IMPRISONED OR
PLACED ON PROBATION, OR HAVE YOU EVER BEEN ORDERED TO DEPOSIT BAIL OR COLLATERAL FOR THE VIOLATION OF ANY LAW, POLICE REGULATION OR ORDINANCE (excluding
minor trafic violations for which a fine or forfeiture of $25, or less was imposed)! INCLUDE ALL COURT MARTIALS WHILE IN MILITARY SERVICE. oO YES iF | NO
IF “‘YES,"’ LIST THE DATE, THE NATURE OF THE OFFENSE OR VIOLATION, THE NAMZ AND LOCATION OF THE COURT OR PLACE OF HEARING, AND THE PENALTY IMPOSED OR OTHER
DISPOSITION OF EACH CASE.

wits RELATE. et rn
4 - b : . tr

“1

19. ARE THERE ANY INCIDENTS IN
YOUR LIFE NOT MENTIONED HEREIN WHICH MAY REFLECT UPON YOUR LOYALTY TO THE UNITED STATES OR UPON YOUR
RE URTHER EXPLANATION? [) Yes oO NO IF “YES.” GIVE DETAILS ne enone

THE DUTIES WHICH YOU MAY BE CALLED UPON To TAKE OR WHICH MIGHT REQUI

613 Docld:34530159 Page 9 Sea Remarks

